Atrioventricular node is responsible for conducting impulse from atria to ventricles.Connexin within atri-oventricular junction play a key role in conducting function of atrioventricular junction;because it presents diversi-fied expression,so its conducting junction is diversified in different areas of atrioventricular junction.Knowing ex-pression type of connexins can approximately determine conductive function in atrioventricular junction area.

Objective·To compare the stress distribution at abutments, edentulous ridge, and peri-implant tissue under the vertical load between the RPI-type removable partial denture supported by implants with different diameter and the conventional RPI-type removable partial denture using a three-dimensional photoelastic method. Methods·The mandibular Kennedy I type denture defect models were fabricated according to the standard mandibular model. Four Straumann system soft tissue level implants with different diameters (two 4.1 mm implants and two 3.3 mm implants) were implanted into the bilateral first molar areas. Planting nails and epoxy resin teeth were inversely put into the mandibular silicone rubber molds to fabricate the epoxy resin photoelastic models and the regular neck (RN) healing abutments were screwed into the implants. A simulated alveolar mucosa with thickness of 2mm and a conventional RPI-type removable partial denture were placed on the epoxy resin models with or without implants. Then a force of 1 kg was vertically applied by a bite force loading device which fixed the model and denture in the centric occlusion. After the stress was frozen, model slices at different areas were cut and the stress fringes were observed. The stress was calculated according to the fringe value of per unit thickness. Results·For the conventional RPI-type removable partial denture, the maximum stress of distal abutment was mainly concentrated on the apical regions and the maximum stress of edentulous ridge was concentrated on the first molar area, particular on the lingual side of alveolar bone. For the implant-supported RPI-type removable partial denture, the maximum stress of distal abutment was lower than that of the conventional RPI-type removable partial denture, and the maximum stress of edentulous ridge (without the implants) was similar to that of abutment and supporting tissues and was lower than that of the conventional RPI-type removable partial denture. The stress around the implant was the largest and the peri-apical stress of implant was greater than the neck stress of implant. Meanwhile, the maximum stress around the implant was increased with the decrease of implant diameter. Conclusion·Compared to the conventional RPI-type removable partial denture, removable partial dentures supported by implants are more stable with a more balanced stress distribution in supporting tissues, thus benefit the health of abutments and supporting tissues.

Objective:To identify the correlation between the progression rate of motor unit number estimate(MUNE) at diagnosis and survival.Methods:We included 129 patents with amyotrophic lateral sclerosis(ALS) enrolled in our hospital from January 2002 to December 2005.We recorded clinical features,ALS functional rating scale(ALSFRS),forced vital capacity(FVC) and electrophysiological data at diagnosis.The patients were monitored every 3 months from visit to death or tracheotomy.Results:Mean age at onset was(52.19?11.00) years.The median survival time from symptom onset was 45.71 months(95% CI = 35 to 51).In univariate analysis of Kaplan-Meier method,outcome was significantly related to progression rate of MUNE(P

Objective To evaluate the efficacy and safety of itopride in the treatment of functional dyspepsia (FD) according to the data of published clinical studies.Methods The papers about randomized controlled trials (RCT) of itopride in treatment of FD were searched from Cochrane library,EMBASE,PubMed,Elsevier,web of science (ISI),China national knonledge internet (CNKI),VIP Chinese Scientific and Technologic Periodical Database and Wanfang data,and the feature information in the studies were extracted.The relative risk (RR) value was used for count data and the weighted mean difference (WMD) was used for measurement data.The proper effect model was selected according to the results of heterogeneity test and the publication bias was investigated through visual inspection of funnel plots.Results A total of nine RCT met the inclusion standard.Of 2620 FD cases,1372 received itopride treatment and 1248 cases received placebo or other medicine as control treatment.The RR value of total effective rates,postprandial fullness and early satiety effective rates in itopride treated FD patients was 1.11 (95％CI:1.01,1.21; P=0.02),1.18 (95％CI:1.04,1.33; P=0.009),1.24 (95％CI:1.01,1.53; P=0.04),which showed the curative effects of itropride group were all better than those of control group.However there was no statistical significance in epigastric discomfort.The WMD of effective rates evaluated with the leeds dyspepsia questionnaire (LDQ) score was-1.38 (95％CI:-1.75,-1.01; P＜0.01),which showed the curative effect of itropride group was better than that of control group.For safety,the adverse effects rates of itopride groups were similar with control groups.The funnel plots of each inspection index presented wide bottom,narrow up and symmetrical graphics,which indicated that there was no publication bias.Conclusion Itopride has better efficacy in general symptoms,postprandial fullness,early satiety and LDQ score in FD patients,and few effects are detected.

Objective To examine the technique of multiple point stimulation for motor unit number estimation (MUNE) and to establish the normative value range in Chinese.Methods Surface-recorded motor unit action potentials were measured in 80 healthy subjects.The compound muscle action potential (CMAP) amplitude measured by maximum baseline to negative peak was recorded.The stimuli sites included the wrist, 6 cm above the wrist, elbow and 6 cm above the elbow along median nerve and ulnar nerve.Individual motor unit responses were obtained by adjusting location of the stimulate electrode and isolating threshold responses with distinct morphologies.Then, stimulus intensity was increased gradually to detect single motor unit action potentials (SMUPs).SMUPs were recorded three times.Stimulating was increase again to record another SMUPs set.Total of 12 SMUPs were recorded.Repeat the whole procedure for two times.Results MUNE was 230.0±35.7 in abductor pollieis brevis muscle, and 242.5±30.2 in aductor digiti minimi muscle for multiple point stimulation.Test-retest correlation coefficients and coefficients of variation for mean of two MUNE were 0.88-0.91 and 13.20%-15.24%.Conclusions The multiple point stimulation is a useful and replicable method to asses the MUNE.

Objective To evaluate the application of upper trapezins muscle electromyography (EMG) in the diagnosis of lower motor neuron damage in bulbar region in amyotrophic lateral sclerosis (ALS). Methods Standard EMG was recorded over upper trapezius muscle in 100 patients with ALS, 80 patients with cervical spondylotic myelopathy (CSM) and 100 normal controls. In groups of ALS and CSM,EMG was also recorded over sternocleidomastoid, rectus abdominis, first dorsal intercostals muscle and tibialis anterior muscles. Among those CSM patients, 43 patients had operations and the EMG on their trapezius muscle was examined at pre-operation and at 3 months post-operation. The parameters of EMG were analyzed between the groups. Results In ALS patients, spontaneous activity in upper trapezius EMG was detected more frequently in patients with disease duration equal to or less than 8 months than the others (21/30(70%) vs 28/70(40%), X~2=7.56, P=0.004). There was no difference in neurogenic EMG changes including abnormal spontaneous potentials and motor unit action petentials (MUAP) between trapezius and sternocleidomastoid in patients with ALS. Significant differences in MUAP were noted between ALS patients((1086.9±152.6)μV, (17.2±6.5) ms,23.6%±3.4%) and controls ((606.7± 82.7)μV,(11.6±1.8) ms,12. 8%±2.2%;q=9.27, 4.57, 4.12, all P<0.01), and between patients with ALS and patients with CSM ((615.7±90.3) μV,(12.1±2.0) ms,13.5%±2.4%,q=8.32,4. 25, 4. 23, all P < 0. 01). Few spontaneous activities in trapezius EMG were detected in post-operation CSM patients. Conclusion EMG in upper trapezius can assist in assessment of clinical and subclinical involvement of bulbar lower motor neurons in patients with ALS, especially at earlier stage.

Objective To study changes of trigemino-cervical reflex (TCR) in patients with Kennedy's disease (KD). Methods The parameters of TCR were analyzed among patients with KD, amyotrophic lateral sclerosis and healthy controls. Results The parameters of ipsilateral P19, N31, A and contralateral P19, N31, A among patients with KD were (23.91±4.84), (35.45±4.76) ms, 1.24± 0.33 and (24.34±4.82), (36.20±4.91) ms, 1.19±0.25, respectively. Compared with the healthy controls((18.37±2.16), (28.50±1.56) ms, 1.90±0.43; (18. 72±2. 18), (29. 19±1.43) ms, 1.84 ± 0. 40), the difference in each parameter was significant (ipsilateral : t = 5.77, 8. 19, -6. 64; contralateral:5.05, 7.62, -7.77, all P<0.01). Conclusion The parameters of TCR were abnormal in KD patients, indicating that the trigeminal nerves and the bulbar may be involved in the disease.

Objective To evaluate the choices and surgical skills for tension-free femoral hernia repair under local anesthesia. Methods The clinical data of 109 nonincarcerated femoral hernia patients were summarized from December 2002 to December 2009. Patients were divided into 3 groups according the time period at which the surgery was performed. 85 patients from 2002 to 2008 were divided into 2 groups,45 cases treated with preperitoneal repair ( preperitoneal group), and the other 40 cases with mesh-plug repair (plug group). The 24 cases admitted from January 2009 to December 2009 received modified preperitoneal repair. Operation time, VAS, length of hospitalization, incidence of recurrence, foreign body feelings and seroma were compared among the three groups. Results All the 109 patients were repaired under local anesthesia, and there was no perioperative death. The statistical indicator value of incidence of recurrence, foreign body sensation and seroma in preperitoneal group was lower than plug group (P ＜0.05). The modified preperitoneal repair was better in operation time, VAS, length of hospitalization than preperitoneal group (P ＜ 0.05). Conclusions Modified preperitoneal repair under local anesthesia is the choice for treating femoral hernia without incarceration. Modified preperitoneal repair is faster, more minimally invasive and faster recovery.

Objective To observe the effect of Xuebijing injection on the expression of tumor necrosis factor-alpha (TNF-α) and high mobility group box-1 protein (HMGB-1) in rat peritoneal mesothelial cells (PMCs) induced by lipopolysaccharide (LPS). Methods PMCs were isolated from rat colic omentum and the 3rd generation cells were used in the experiment. PMCs were incubated with LPS at different concentrations (1,10,100 mg/L);with LPS (10 mg/L) for 2, 6, 12, 18, 21, 24, 36 h;with Xuebijing injection at different concentrations (2,10,20 g/L) after incubation with LPS (10 mg/L) for 2 h. PMCs in the control group were incubated with medium. HMGB-1 mRNA was detected by RT-PCR. TNF-α and HMGB-1 protein in supernatants was detected by ELISA. Results Compared to the control group, the expression of HMGB-1 mRNA and protein was significantly increased in groups stimulated by LPS in a time- and dose-dependent manner (all P<0.05);the expression of TNF-α was increased in the groups stimulated by LPS in a dose-dependent manner (P<0.05). In the groups stimulated by LPS (10 mg/L), the expression of TNF-α appeared double hump within 36 hours. Compared to LPS (10 mg/L) group, Xuebijing injection significantly inhibited the expression of HMGB-1 and TNF-α (all P<0.05 ) in a dose-dependent manner. Conclusions HMGB-1 as a late mediator of inflammatory responses may play a role in the pathogenesis of peritoneal dialysis related peritonitis. Xuebijing injection can reduce peritoneal inflammatory impairment by inhibiting the up-regulation of TNF-α and HMGB-1 induced by LPS.

Objective To investigate cervical spinal upper motor neuron (UMN) dysfunction in patients with frail arm syndrome (FAS) by physical examination,triple stimulation technique (TST) and pectoralis tendon reflex tests.Methods Sixty-seven FAS patients,coming from Peking University Third Hospital from June 2013 to June 2016,underwent physical examination and routine electrophysiological tests.The pyramid signs,the results of pectoralis tendon reflex and TST were collected to estimate the function of cervical spinal UMN.Results On the time of diagnosis,weakness of bilateral proximal upper limbs was found in 61 patients,while weakness of unilateral proximal upper limb was found in six patients.There were 25 patients with tendon hyperreflexia,20 patients with tendon hyporeflexia and 22 patients with tendon areflexia.All the patients were pectoral muscle tendon hyperreflexia except one.UMN score of cervical region was 2.0 ± 0.5.Lower motor neuron score of cervical region was 2.0 ± O.2.The amplitude ratio of TSTtest/TSTcontrol was 78.31％ ± 6.52％.The latency and amplitude of quantitative detection of pectoralis tendon reflex was (7.80 ± 1.22) ms and (1.23 ± 0.14) mV,respectively.In the follow-up study,the tendon reflexes and the UMN score declined,the amplitude ratio of TSTtest/TSTcontrol decreased,while the lower motor neuron score increased and the latency of quantitative detection of pectoralis tendon reflex remained almost unchanged.Conclusion The results showed that there was cervical spinal UMN dysfunction in patients with FAS,and the pyramid signs were often concealed by muscle atrophy with progression of the disease.